• Responsible for managing and processing patient billing and medical claims, ensuring accuracy and compliance with healthcare regulations. Their duties include submitting claims to medical aids, resolving billing discrepancies, verifying patient and scheme information, and maintaining billing systems and client accounts.

Job Description

• Final assessment of all patient files to ensure all billing is aligned with the billings guidelines
• Final assessment of all patient files to ensure that all documentation is in file
• Requesting authorization from Medical Insurers/Administrators
• Ensuring all claims are billed accurately according to recommended tariff
• Timeous final billing of claims to maintain the target of final billing of files within 3 days
• Submission of WCA, COID claims to respective funders
• Timeous Escalation of cases within turnaround time where level if care and Codes are not approved to maintain the target of accurate final billing of files within 3 days
• Application of clinical knowledge in reviewing ICD coding of patient accounts
• Ensure that all claims are submitted timeously via the Medikredit Panel
• Timeous escalation of any Medikredit Rejections and maintain a high level of integrity of the Medikredit Panel
• Follow up with external service providers and stakeholders on outstanding documentation required for the accurate final billing of files to maintain the target of final billing files within 3 Days
• Timeous resolution of queries emanating from final billed files to maintain targets and objectives
• Daily authorization requests from various institutes
• Daily follow up on payment received and providing accurate feedback to the Operations Manager
• Assist with the crew with calls received and allocating accordingly.
• Follow up with external service providers and stakeholders on outstanding documentation required for the accurate final billing of files to maintain the target of final billing files within 3 Days
• Daily follow up on payment received and providing accurate feedback to the Operations Manager
• Following up and resolving queries from internal and external customers and stakeholders
• Daily and weekly reports
• Adherence to deadlines
• Administrative tasks as requested by Management for Operational efficiency
• Assist with banking
• Liaising with patients for queries
• General filing
• Ability to stay abreast of industry trends and knowledge
• Keep up to date and compliance with Melomed’s Policies and Procedures
• Maintain and sustain working key internal and external relationships
• Stand in for Melomed Claremont Reception Administrator during leave

Job Requirements

• 3 Years’ Experience in a hospital environment
• Experience in Scale of Benefits and Alternate Reimbursement Models
• Experience in National Hospitals Network (NHN) Billings would be advantageous
• Knowledge of applicable statutory acts such as Consumer Protection Act; PMB; POPIA, etc.
• Proficiency in Computer Literacy
• Good communication and interpersonal skills
• Attention to detail and excellent organizational skills
• Time Managing Skills
• Ability to adapt and respond to change
• Professional Work Ethic
• Organizational awareness
• Customer Centric
• Team Player
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